新辅助治疗在cT2N0期食管癌患者中的临床意义:一项荟萃分析  

Clinical significance of neoadjuvant therapy in patients with cT2N0 esophageal cancer:a meta-analysis

作　　者：宋佩东 陈东来[2] 薛宇航 王伟[1] 陈勇兵[1] 桑永华[1] 杨文涛[1] Song Peidong;Chen Donglai;Xue Yuhang;Wang Wei;Chen Yongbing;Sang Yonghua;Yang Wentao(Department of Thoracic Surgery,the Second Affiliated Hospital of Soochow University,Suzhou 215004,China;Department of Thoracic Surgery,Shanghai Pulmonary Hospital,Tongji University,School of Medicine,Shanghai 200433,China)

机构地区：[1]苏州大学附属第二医院胸心外科,苏州215004 [2]同济大学附属上海市肺科医院胸外科,上海200433

出　　处：《中华胸部外科电子杂志》2021年第4期247-256,共10页CHINESE JOURNAL OF THORACIC SURGERY：Electronic Edition

基　　金：江苏省科技厅社会发展-重点项目(BE2020653);苏州市重点学科项目(SZXK201803);苏州市胸部肿瘤重点实验室项目(SZS201907);苏州市科技发展(民生科技)项目(SS2019061);苏州大学附属第二医院学科建设托举工程项目(XKTJ-XK202004)。

摘　　要：目的明确新辅助治疗在cT2N0期可切除食管癌患者中的临床意义。方法通过网上检索包括PubMed、Web of Science、EMBASE、the Cochrane Library、中国知网等一系列数据库,筛选符合本研究目的的真实世界研究,从中提取包括生存率、病理分期改变、切缘阳性、术后吻合口瘘等多种结局指标。通过RevMan 5.4与R version 4.0.2等数据分析软件对其进行荟萃分析。结果累计筛选出7项研究,共4602例cT2N0食管癌患者纳入分析,荟萃分析表明新辅助联合手术治疗组(NS)与单纯手术组(S)在5年生存率、无复发生存率、术后吻合口瘘发生率与病理升期方面差异均无统计学意义(P>0.05);然而两组在术中切缘阳性以及病理降期上差异均有统计学意义(P<0.05)。结论新辅助治疗联合手术较单纯手术并未给cT2N0食管癌患者带来明显生存获益及更高的吻合口瘘风险,也未降低病理升期风险,但应用新辅助治疗可有效降低病理分期以及术中切缘阳性的概率。推荐对于检查完善且胃镜病理提示不含高危因素的cT2N0食管癌患者可直接行手术治疗。Objective To evaluate the clinical significance of NS in patients with cT2N0 resectable esophageal cancer.Methods Real-world studies were identified by searching databases including PubMed,Web of Science,EMBASE,Cochrane Library and China National Knowledge Infrastructure(CNKI).Data on 5-year overall survival,pathological upstaging and downstaging,margin positive rate and anastomotic leakage were extracted to assess the pros and cons of NS.The meta-analysis was performed using RevMan 5.4 and R version 4.0.2.Results A total of 4602 patients from 7 real-world studies were included.The pooled results suggested that there were no significant differences in the 5-year overall survival and recurrence free survival between neoadjuvant plus surgery(NS)group and surgery alone(S)group.The pooled evidence also indicated that the NS group shared similar risk of postoperative anastomotic leakage and pathological upstaging to the S group.However,the NS group exhibited its value in pathological downstaging and reduced positive margin compared with the S group(P<0.05).Conclusion This study indicates that NS is not significantly associated with better long-term survival and higher probability of anastomotic leakage or pathological upstaging compared with S,but NS exhibits significant advantages in pathological downstaging as well as margin positive rate.It is recommended that upfront surgery should be considered for patients receiving thorough preoperative examinations whose gastroscopy-based pathology reports reveal no major risk factors.

关 键 词：新辅助治疗 食管癌 cT2N0 荟萃分析 

分 类 号：R735.1[医药卫生—肿瘤]